Hx
Untreated steptococcal pharyngitis
Developing nations due to lack of access to antibiotics
Sx
New murmur
Cardiac failure
Polyarthritis
Migratory in nature and usually affects lower extremity joints first
Carditis
Chorea
Skin lesions known as Erythema Marginatum
Subcutaneous nodules
Dx
ASO titer provides evidence of recent streptococcal infection and is positive in patients with acute rheumatic fever
Jones criteria is used for diagnosis
Evidence of a Group A Strep infection along with
2 major criteria OR
1 major criterion plus 2 minor criteria
Major criteria
Carditis (e.g. pericarditis, CHF, or new heart murmur--mitral stenosis is the most common valvular complication of rheumatic fever)
Poly-arthritis
-migratory in nature and usually affects the lower extremity joints first
Chorea
Rash (erythema marginatum)
Subcutaneous nodules
Minor criteria
Arthralgias
Fever
Elevated acute phase reactants
Prolonged PR interval
Tx
Repeated episodes of rheumatic fever can worsen valvular function. Therefore it is recommended that patients with a prior episode of rheumatic fever be given antibiotic prophylaxis with penicillin to prevent a recurrence. The duration of treatment is not firmly established, but most physicians will treat until the patient reaches the age of 18.
Patients who have had an episode of rheumatic fever should receive antibiotic prophylaxis with penicillin to prevent further attacks
Complications
Pulmonary congestion
Sx
Exertional dyspnea
Nocturnal cough
Hemoptysis
Mitral stenosis, leading to
Left atrial dilation and subsequently atrial fibrillation
